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Expanding the populations served by intensive interdisciplinary pain treatment: An interactive discussion of clinical successes and failures, insights from data, unique needs of specific groups and potential common mechanisms of action
Panel Discussion
Panelists will incorporate brief presentations of large-scale outcome data and clinical case studies for specific conditions and populations that have been treated – successfully or unsuccessfully – in their IIPT programs. For example: The Boston Children’s Hospital’s Pediatric Pain Rehabilitation Center (PPRC) is one of the first pediatric IIPTs in the US, with a strong track record of clinical success. Dr. Logan will present initial outcomes from a newly opened Young Adult pain rehabilitation program and describe recent interdisciplinary efforts to modify the PPRC treatment to meet the unique developmental needs of this patient population. Drawing from experiences across the 15 years of the PPRC’s existence and its large patient population Dr. Logan will also contribute case examples and program modifications to illustrate successes and challenges in the treatment of patients representing diverse presentations, comorbidities, and identities. Within the Bath Center for Pain Services, approximately 25% of our pediatric patients are neurodiverse, 9% identify as gender diverse, and 24% as other than heterosexual; in contrast, the patient population is less ethnically diverse than the UK as a whole. Dr. Connell will review service adaptations to maximize inclusion, particularly in the context of recent authoritative UK guidance on gender identity services. In response to data from a UK national specialist service showing that Young Adults have different drivers of disability and physical performance to older working-age adults, Dr. Connell will present the argument against ‘lumping’ this group into adult services and describe how the Bath Programme has met the unique developmental needs of this group of patients. Children’s Hospital Los Angeles serves an exceptionally diverse patient population. Patients seen in the Pain Medicine Clinic are on average at the 69%ile on the US Census Social Vulnerability Index. The range of patients span from the 0.1% to 99%. 14% of families state that English is not their primary language. These factors can lead to health disparities that require a tailored approach in IIPT to work toward health equity in the context of chronic pain and the IIPT setting. Dr. Kim will discuss successes and challenges in working with diverse patient populations. Approximately 40% of the patients seen at the Mayo Clinic Pediatric Pain Rehabilitation Center have autonomic dysfunction or POTS. Dr. Harbeck-Weber will briefly present large n data demonstrating the effectiveness of IIPT model with this population, and discuss the additional complications in treating this population within this model. Recently, almost 10% of patients seen in the Mayo IIPT have been gender-diverse; Dr. Harbeck-Weber will present strategies to foster IIPT success for these patients, using data to support her recommendations. Children’s Mercy’s Rehabilitation for Amplified Pain Syndromes (RAPS) program has treated several hundred young people with chronic pain conditions over the past 11 years, has specifically worked to identify and safely treat individuals with hypermobility in a program that includes intensive exercise, and has tracked outcomes including injury, functioning, and changes in pain during and after program participation. The team has also conducted neuropsychological assessment of nearly all patients, allowing them to identify and provide guidance to individuals with neurodivergent conditions such as ADHD, Autism, and Nonverbal Learning Disability. Dr. Wallace will present outcomes data on the success rates of these patients in the RAPS program and describe how this interdisciplinary team has worked together to facilitate improvement during intensive treatment and to set these youth up for continued success in safely returning to physical and academic activities after program completion.